THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

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Effective Date: July 18, 2025

 

Our Commitment to Your Privacy

 

At Kemp Chiropractic Clinic, we are dedicated to maintaining the privacy of your Protected Health Information (PHI). We are required by law to maintain the privacy of your health information and to provide you with this Notice of our legal duties and privacy practices with respect to PHI. When we use or disclose your PHI, we are bound by the terms of this Notice.

This Notice applies to all PHI that we maintain, whether created or received by us.

 

How We May Use and Disclose Your Protected Health Information (PHI)

 

The law allows us to use and disclose your PHI for certain purposes without your prior written authorization. These purposes include, but are not limited to, the following:

1. For Treatment: We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes sharing information with other healthcare providers involved in your care, such as referring physicians, specialists, or therapists, to ensure coordinated and continuous care. For example, your chiropractor may discuss your treatment plan with another healthcare provider.

2. For Payment: We may use and disclose your PHI to obtain payment for the healthcare services we provide to you. This includes activities such as billing, claims management, and determinations of eligibility or coverage. For example, we may send your PHI to your insurance company or another third-party payer to obtain payment for the chiropractic services rendered.

3. For Healthcare Operations: We may use and disclose your PHI for our healthcare operations. These are activities that are necessary to run our clinic and ensure that our patients receive quality care. Examples include: * Quality assessment and improvement activities. * Professional peer review and performance evaluations. * Training programs for students or new staff. * Accreditation, certification, licensing, or credentialing activities. * Business planning and development. * Administrative and support services (e.g., legal, auditing, and general business management).

4. Appointment Reminders and Follow-Up Communications: We may use and disclose your PHI to contact you with appointment reminders (such as voicemail messages, texts, or postcards) or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

5. Individuals Involved in Your Care or Payment for Your Care: We may disclose your PHI to a family member, other relative, or close personal friend who is involved in your care or payment for your care, if you agree or if we determine, based on our professional judgment, that it is in your best interest.

6. Disaster Relief Efforts: We may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

7. As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law.

8. Public Health Activities: We may disclose your PHI to a public health authority for purposes such as: * Preventing or controlling disease, injury, or disability. * Reporting births and deaths. * Reporting reactions to medications or problems with products. * Notifying people who may have been exposed to a disease or are at risk of spreading a disease or condition. * Conducting public health surveillance, investigations, and interventions.

9. Victims of Abuse, Neglect, or Domestic Violence: We may disclose your PHI to the appropriate government authority if we believe you are a victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

10. Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.

11. Judicial and Administrative Proceedings: We may disclose your PHI in the course of any judicial or administrative proceeding, in response to a court order, subpoena, discovery request, or other lawful process, if certain conditions are met.

12. Law Enforcement Purposes: We may disclose your PHI to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person; reporting crimes on our premises; and in emergencies to report a crime.

13. Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death, or other duties authorized by law. We may also disclose PHI to funeral directors as necessary to carry out their duties.

14. Organ, Eye, or Tissue Donation: We may disclose PHI to organizations involved in procuring, banking, or transplanting organs, eyes, or tissue for donation and transplantation.

15. Research: We may use and disclose your PHI for research purposes under certain limited circumstances, provided the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHi.

16. Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

17. Specialized Government Functions: We may disclose your PHI for certain specialized government functions, such as to military authorities if you are a member of the armed forces, or for national security and intelligence activities.

18. Workers' Compensation: We may disclose your PHI as authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law.

 

Uses and Disclosures Requiring Your Written Authorization

 

For any purpose other than those described above, we will use or disclose your PHI only with your specific written authorization. This includes:

• Most uses and disclosures of psychotherapy notes (if applicable).

• Uses and disclosures for marketing purposes.

• Disclosures that constitute a "sale" of PHI.

You have the right to revoke any such authorization at any time by notifying us in writing. Your revocation will not affect any use or disclosure of your PHI that occurred while the authorization was in effect.

 

Your Rights Regarding Your Protected Health Information (PHI)

 

You have the following rights regarding the PHI we maintain about you:

1. Right to Inspect and Copy Your Health Information: You have the right to inspect and obtain a copy of your PHI that we maintain in our designated record set. This right does not apply to psychotherapy notes or information compiled in anticipation of litigation. We may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.

2. Right to Amend Your Health Information: If you believe that the PHI we have about you is incorrect or incomplete, you may request that we amend it. Your request must be in writing and provide a reason supporting your request. We may deny your request under certain circumstances, but we will notify you in writing of our decision.

3. Right to an Accounting of Disclosures: You have the right to request an "accounting" of certain disclosures of your PHI made by us. This accounting will not include disclosures made for treatment, payment, healthcare operations, or those made directly to you or your authorized representative. Your request must state a time period, which may not be longer than six years.

4. Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a restriction on our disclosure of your PHI to individuals involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request, unless: * The disclosure is to a health plan for purposes of carrying out payment or healthcare operations (and not for treatment); AND * The PHI pertains solely to a healthcare item or service for which you, or someone on your behalf, has paid us in full out of pocket.

5. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

6. Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may ask us for a copy of this Notice at any time.

7. Right to Be Notified of a Breach: You have the right to be notified in the event of a breach of your unsecured PHI.

To exercise any of these rights, please submit a written request to our Privacy Official at the contact information provided below.

 

Our Responsibilities

 

Kemp Chiropractic Clinic is required by law to:

• Maintain the privacy of your PHI.

• Provide you with this Notice of our legal duties and privacy practices with respect to your PHI.

• Abide by the terms of this Notice currently in effect.

• Notify you if we are unable to agree to a requested restriction.

• Accommodate reasonable requests you have to communicate PHI by alternative means or at alternative locations.

• Notify you following a breach of unsecured PHI.

We reserve the right to change the terms of this Notice at any time. Any changes will apply to all PHI that we maintain. If we make material changes to this Notice, we will post the revised Notice on our website (https://kempdc.com) and make copies available at our clinic.

 

Complaints

 

If you believe your privacy rights have been violated, you may file a complaint with Kemp Chiropractic Clinic or with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.

To file a complaint with Kemp Chiropractic Clinic, please contact our Privacy Official at the information below.

To file a complaint with the Secretary of the Department of Health and Human Services, you may contact them at:

Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 1-877-696-6775 www.hhs.gov/ocr/privacy/hipaa/complaints/

 

Contact Information

 

If you have any questions about this Notice or our privacy practices, please contact our Privacy Official at:

 

Privacy Official

Kemp Chiropractic PA

4169 University Blvd S

904.737.2350

kempchiropractic@comcast.net